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Cisterna Chyli: An Incidental Finding on MR Cholangiopancreatography

Aye Erden

Ankara University Ankara 06100, Turkey

Cisterna chyli, the initial prominent segment of the thoracic duct, lies on the anterior aspect of the vertebral column from T12 to L2 [1]. It is a saclike structure formed by the junction of the lumbar, intestinal, and descending intercostal lymphatic trunks. From there, the lymph channels continue to the thoracic duct to empty into the left subclavian vein. The signal intensity characteristics of the cisterna chyli on MRI are the same as those for static or slow-moving fluids [2, 3]. Thus, high signal intensity is expected on MR hydrography techniques.

A 37-year-old man was referred for MR cholangiopancreatography (MRCP) because of a presumptive diagnosis of primary sclerosing cholangitis. Intra- and extrahepatic bile duct findings were normal on MRCP. A tubular structure of high signal intensity consistent with a cisterna chyli measuring 28 x 9 x 8 mm was seen at the mid abdomen (Fig. 2). On axial images, it was at the retrocrural spaceing located on the right and posterolateral to the aorta. Although this lymph-containing sac may be mimicked by necrotic retrocrural lymphadenopathy on MRCP images, knowing its typical location and configuration is helpful in the differential diagnosis. If its nature requires clarification, axial images confirm its location and clarify its relationship to adjacent anatomic structures.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —Coronal thick-slab (40 mm) MR cholangiopancreatogram in 37-year-old man with elevated serum levels of alkaline phosphatase and -glutamyl transferase shows cisterna chyli (arrow) at level of first and second lumbar vertebrae. Cisterna chyli has high signal intensity because of its lymph content and roughly fusiform appearance.

References

1. Rosenberger A, Abrams HL. Radiology of the thoracic duct. AJR 1971;11:807 –820
2. Gollub MJ, Castellino RA. The cisterna chyli: a potential mimic of retrocrural lymphadenopathy on CT scans. Radiology1996; 199:477 –480[Abstract/Free Full Text]
3. Hayashi S, Miyazaki M. Thoracic duct: visualization on nonenhanced MR lymphography: initial experience. Radiology1999; 212:698 –600

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Erden, A. Search for Related Content PubMed PubMed Citation Articles by Erden, A. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?